2017-18 HSC Section 4 Green Book

Reprinted by permission of JAMA Facial Plast Surg. 2017; 19(1):64-71.

Clinical Review & Education

JAMA Facial Plastic Surgery | Review

Energy-Based Facial Rejuvenation Advances in Diagnosis and Treatment

Christopher J. Britt, MD; Benjamin Marcus, MD

IMPORTANCE The market for nonsurgical, energy-based facial rejuvenation techniques has increased exponentially since lasers were first used for skin rejuvenation in 1983. Advances in this area have led to a wide range of products that require the modern facial plastic surgeon to have a large repertoire of knowledge.

OBJECTIVE To serve as a guide for current trends in the development of technology, applications, and outcomes of laser and laser-related technology over the past 5 years.

EVIDENCE REVIEW We performed a review of PubMed from January 1, 2011, to March 1, 2016, and focused on randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidelines including case control, case studies and case reports when necessary, and included 14 articles we deemed landmark articles before 2011. FINDINGS Three broad categories of technology are leading non–energy-based rejuvenation technology: lasers, light therapy, and non–laser-based thermal tightening devices. Laser light therapy has continued to diversify with the use of ablative and nonablative resurfacing technologies, fractionated lasers, and their combined use. Light therapy has developed for use in combination with other technologies or stand alone. Finally, thermally based nonlaser skin-tightening devices, such as radiofrequency (RF) and intense focused ultrasonography (IFUS), are evolving technologies that have changed rapidly over the past 5 years. CONCLUSIONS ANDRELEVANCE Improvements in safety and efficacy for energy-based treatment have expanded the patient base considering these therapies viable options. With awide variety of options, themodern facial plastic surgeon can have a frank discussionwith the patient regarding nonsurgical techniques that were never before available. Many of these patients can nowderive benefit from treatments requiring significantly less downtime than beforewhile the clinician can augment the treatment tomaximize benefit to fit the patient’s time schedule.

Author Affiliations: Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison. Corresponding Author: Christopher J. Britt, MD, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Room K4-721, Madison, WI 53705 ( cbritt4@gmail.com ).

T he term laser originated from an acronym that stands for light amplification by stimulated emission of radiation. Its use is a cornerstone for today’s facial plastic surgeon ( Figure 1 ). The landmark article by Anderson and Parrish 1 in 1983 on selective photothermolysis began the era of laser-therapy skin re- juvenation. These techniques were expanded on byManstein et al 2 in the seminal article on fractional photothermolysis in 2004. This leap in laser technology reduced scarringby usingmicroscopic treat- ment zones used to promote tissue remodeling and ushered in an era inminimal downtime after laser therapy. Over the past decade, laser technology, in addition to intense pulsed light (IPL), radiofre- quency devices, and focusedhigh-frequency ultrasonography tech- nologies, has increased options for patients in facial rejuvenation, resurfacing, and tightening. With the advent of such technologies, both supply and de- mand have increased at incredible speeds. According to the Ameri- can Society for Plastic Surgery statistics, which provide a compre- JAMA Facial Plast Surg . 2017;19(1):64-71. doi: 10.1001/jamafacial.2016.1435 Published online December 1, 2016.

hensive estimate on the total number of cosmetic procedures performed in the United States, minimally invasive cosmetic pro- cedures laser resurfacing procedures have increased by more than 200% since 2000. In 2014, more than 540 000 laser skin- resurfacing procedures were performed with a 6% increase from 2013, 87%of whichwere performed inwomen. 3 These statistics do not include the large number of non–laser-based products used for facial rejuvenation and tightening or light-based facial rejuvena- tion technologies. With the ever-expanding repertoire of technol- ogy and products, it is important to understand the efficacy of each to match the demand.

Methods We performed a review of PubMed from 2011 to 2016 using spe- cific search strategies, modeled after systematic reviews but con-

JAMA Facial Plastic Surgery January/February 2017 Volume 19, Number 1 (Reprinted)

jamafacialplasticsurgery.com

42